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Working with Workers' Compensation Medical Billing Codes


When reimbursements are low for your workers' compensation patients, it may not be the payers' fault. Here's how to make sure you are paid what you deserve.

With reimbursements dropping significantly over the past few years, physicians like you are looking to cut costs and possibly staff. I have an alternative. Let's look at your coding again. I've spoken about this previous blog posting regarding putting the most expensive code first to maximize your reimbursement for payers that cascade those reimbursements. But, were you aware that if you see any workers' compensation patients that there may be alternative codes that you are required to use?

In many states, workers' compensation programs have a whole separate set of codes to use when billing for your services. I've recently been alerted to an issue regarding this very thing. Something was just not adding up regarding some statistical data. In looking a little deeper, I found that the billing department had been changing some of the codes that were entered by the front office staff. Looking even deeper, I found out why. In the state of California, most all workers' compensation plans have their own set of codes, and the individuals entering the treatment codes were not using the appropriate ones.

Here's what ended up happening: Some codes made it through and over to the insurance company. The incorrect codes were denied. The billing company did not resubmit with the correct codes. Instead, a very small amount was actually posted to the patients account. What does this mean for you? LOST REVENUE!

Here are some easy steps you can take to insure this does not happen at your Practice :

• When seeing a workers' compensation patient, have your front office staff alert you to this. They can use a highlighter to color over the patient's name, or even something as simple as writing two letters “WC” next to the patient's name.

• When submitting your codes, be sure you have the workers' compensation fee schedule in front of you, that way you know exactly which codes to use.

• If you have someone else (back office, for example) review your coding, be sure that they are acting as your fail-safe. They may have an idea or two how to catch these prior to being sent to your billing department or out to the insurance company for reimbursement.

• During your billing department's accounts receivable review, be sure they are keeping a very close watch on the workers' compensation category and make sure no non-workers' compensation codes slipped through. If they did, be sure you and your billing department have the understanding that nothing under these circumstances is to be adjusted off without contacting your office for alternative codes, first.

These simple tips will allow you to continue with your day, without distraction. You have enough to do with seeing patients and documenting the visits to have to worry about this. Involve your staff and come up with a solid procedure for managing these types of accounts.

Find out more about P.J. Cloud-Moulds and our other Practice Notes bloggers.

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